Provider Demographics
NPI:1407201130
Name:BJORN, KIMBERLEY (LICSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:
Last Name:BJORN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13201 130TH STREET KP N
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98329-5141
Mailing Address - Country:US
Mailing Address - Phone:253-208-3526
Mailing Address - Fax:
Practice Address - Street 1:615 N 2ND ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-2232
Practice Address - Country:US
Practice Address - Phone:253-208-3526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW600434681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical